Author Interviews, JAMA, Neurological Disorders, Ophthalmology, Vanderbilt / 11.08.2015
Traditional Treatments For Central Retinal Artery Occlusion May Be Worse Than No Treatment
MedicalResearch.com Interview with:
Matthew Schrag MD
Department of Neurology
Yale University
New Haven, Connecticut
Medical Research: What is the background for this study? What are the main findings?
Dr. Schrag: Central retinal artery occlusion (CRAO) is a relatively rare disorder that is caused by interruption of blood flow to the retina, usually by a clot or some other embolus. Despite around 150 years of research, no compelling treatment has been found for this disease. Treatment with fibrinolytics has been used experimentally for a long time and some of the results have been encouraging. The point of the current study was to aggregate all of this observational data and compare how patients withCentral retinal artery occlusion do when treated with fibrinolytics versus when they are treated with other approaches or not treated at all.
The biggest surprise in the data was the poor performance of conventional treatments at less than half the recovery rate of patients who were simply left alone. The literature on treating central retinal artery occlusion with ocular massage, hemodilution or anterior chamber paracentesis has never been particularly compelling, but these treatments were thought to be harmless and are often practiced in the acute management of central retinal artery occlusion. This new analysis strongly suggests that these interventions may be harmful. While this data is not perfect (it is retrospective, non-randomized, acquired over long periods of time, etc), for me it raises enough doubt that I think ocular massage, anterior chamber paracentesis and hemodilution should be abandoned as treatments for acute CRAO.
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